The role and timing of decompression in acute spinal cord injury: What do we know? What should we do?

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2001-12, Vol.26 (24), p.S101-S110
• Main Authors: FEHLINGS, Michael G, SEKHON, Lali H. S, TATOR, Charles, SILBER, Jeff S, VACCARO, Alexander R
• Format: Article
• Language: English
• Subjects: Acute Disease; Animals; Biological and medical sciences; Cerebrospinal fluid. Spinal cord. Spinal roots. Spinal nerves; Decompression, Surgical; Disease Models, Animal; Evidence-Based Medicine; Humans; Length of Stay - statistics & numerical data; Medical sciences; Neurosurgery; Spinal Cord Injuries - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/00007632-200112151-00017

The management of acute spinal cord injury has traditionally concentrated on preventative measures as well as, for the better part of the previous century, conservative care. Pharmacologic interventions, in particular intravenous methylprednisolone therapy, have shown modest improvements in clinical trials and are still undergoing evaluation. More recent interest has focused on the role of surgical reduction and decompression, particularly "early" surgery. A review of the current evidence available in the literature suggests that there is no standard of care regarding the role and timing of surgical decompression. There are insufficient data to support overall treatment standards or guidelines for this topic. There are, however, Class II data indicating that early surgery (